Mitral stenosis of rheumatic etiology: A case report

Abstract

Introduction: Mitral stenosis impedes blood flow from the left atrium to the left ventricle. Rheumatic fever is the main etiology, and 60% evolve into rheumatic heart disease (RHD). Among the most frequent complications we have: Acute pulmonary edema, atrial fibrillation, systemic embolisms and chest pain. The diagnosis of valvular heart disease is made through physical examination and complementary methods such as electrocardiogram and echocardiography. Case presentation: A 56-year-old female patient was referred for cardiology consultation due to two episodes of acute pulmonary edema associated with rapid palpitations. The electrocardiogram (ECG) reported atrial fibrillation with preserved ventricular response. Transthoracic echocardiogram showed a severe mitral stenosis, with left atrial enlargement, thrombi in the roof of the left atrium and moderate tricuspid insufficiency.  Diagnosis of mitral valve disease of rheumatic etiology was established. Treatment was started with bisoprolol, furosemide, digoxin, rivaroxaban or warfarin. After several months of follow-up, the patient died. Discussion and Conclusion: It is important to highlight the clinical presentation of the disease, endemic areas of rheumatic fever, and the probability that a patient with signs and symptoms of heart failure could have rheumatic valve disease. Similarly, the  therapeutic management of the patient, highlighting the use of vitamin K antagonists and not new oral anticoagulants, maintaining an INR of 2 and 3, in patients with new onset or paroxysmal atrial fibrillation, and patients in sinus rhythm with a history of systemic embolic events, thrombi in the left atrium, and left atrial enlargement.